Provider Demographics
NPI:1902695828
Name:MCCULLOUGH, ALICE (CPED)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2734
Mailing Address - Country:US
Mailing Address - Phone:301-777-7336
Mailing Address - Fax:301-777-3860
Practice Address - Street 1:686 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2734
Practice Address - Country:US
Practice Address - Phone:301-777-7336
Practice Address - Fax:301-777-7336
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPED4778224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist